益气活血化瘀法联合激光治疗视网膜静脉阻塞的临床疗效观察

发布时间：2018-08-18 13:50

【摘要】：目的：通过对益气活血化瘀法联合激光治疗视网膜静脉阻塞(retinal vein occlusion, RVO)疗效的观察,来探讨益气活血中药在治疗视网膜静脉阻塞中所取得的良好疗效及机制,为视网膜静脉阻塞的预防和治疗提供新思路和新途径。方法：将RVO患者60例60只眼,采用随机原则分组治疗,分为治疗组和对照组。其中治疗组31例31只眼,根据中医辨证应用补阳还五汤加减配合激光光凝治疗；对照组(单纯激光组)29例29只眼,采用单纯激光治疗,治疗一个月后观察两组的临床疗效。结果： 1.两组治疗视力比较差异具有统计学意义(P0.05),补阳还五汤加减配合激光光凝治疗疗效优于单纯激光组,治疗组有效率93.55%,对照组89.66%。 2.两组治疗眼底出血渗出吸收比较,差异具有统计学意义(P0.01),治疗组疗效优于对照组。 3.两组治疗后视力起效时间比较,P0.01,有非常显著性差异。 4.两组治疗后OCT检查黄斑水肿改善情况比较,具有非常显著性差异(P0.01)。 5.两组患者治疗一个月后视网膜循环时问(RCT)明显缩短,与治疗前比较有显著性差异(P0.05)。治疗组与对照组治疗后比较,P=0.0320.05,有显著性差异。 (6)两组总体疗效比较,差异具有统计学意义(P0.05),治疗组与对照组总体疗效的有效率分别是96.77%、89.66%,治疗组疗效优于对照组。结论： 1.两种治疗方法对本病均有一定疗效,激光光凝能减少毛细血管渗漏,形成屏障,阻止液体渗入黄斑；封闭无灌注区,预防新生血管形成；封闭新生血管及减少和防止玻璃体出血。中药能促进眼底出血和渗出灶的吸收,并改善黄斑水肿,从而有效的防止视网膜静脉阻塞远期并发症产生和有利于近期并发症的治疗。中药联合激光则能发挥两者的优势,加速眼底出血的吸收,从而缩短病程提高疗效,故治疗组疗效更优于对照组。 2.中药在激光围手术期具有促进视网膜出血、渗出的吸收,弥补激光治疗引起的视网膜灼伤的不良反应,以增强激光疗效。而这协同可明显提高患者视力,缩短病程,减少视细胞的损害,明显改善视功能。
[Abstract]:Objective: to observe the curative effect of tonifying qi, activating blood circulation and removing blood stasis combined with laser in the treatment of retinal vein occlusion (retinal vein occlusion, RVO), and to explore the good curative effect and mechanism of traditional Chinese medicine for invigorating qi and activating blood circulation in the treatment of retinal vein occlusion. To provide new ideas and approaches for the prevention and treatment of retinal vein occlusion. Methods: 60 cases (60 eyes) of RVO were divided into treatment group and control group. 31 eyes of 31 cases in the treatment group were treated with Buyang Huanwu decoction combined with laser photocoagulation according to TCM syndrome differentiation, and 29 eyes of 29 cases in the control group (simple laser group) were treated with laser alone, and the clinical effects of the two groups were observed after one month of treatment. Results: 1. The difference of visual acuity between the two groups was statistically significant (P0.05). The curative effect of Buyang Huanwu decoction combined with laser photocoagulation therapy was better than that of the simple laser group. The effective rate of the treatment group was 93.55, and that of the control group was 89.66.2. The difference between the two groups was statistically significant (P0.01). The curative effect of the treatment group was better than that of the control group. The visual acuity of the two groups was significantly different from that of the control group (P 0.01). There was a significant difference between the two groups in the improvement of macular edema by OCT (P0.01). After one month of treatment, the (RCT) of the two groups was significantly shorter than that before treatment (P0.05). There was significant difference between the treatment group and the control group after treatment. (6) the overall curative effect of the two groups was statistically significant (P0.05). The effective rate of the treatment group and the control group was 96.777.89. 666.The curative effect of the treatment group was better than that of the control group. Conclusion: 1. Laser photocoagulation can reduce capillary leakage, form barrier, prevent fluid from infiltrating into macula, seal no perfusion area and prevent neovascularization. Block neovascularization and reduce and prevent vitreous hemorrhage. Traditional Chinese medicine can promote the absorption of fundus hemorrhage and exudation, and improve macular edema, which can effectively prevent the long-term complications of retinal vein occlusion and the treatment of short-term complications. Chinese medicine combined with laser can play the advantage of both, accelerate the absorption of fundus haemorrhage, thus shorten the course of disease and improve the curative effect, so the curative effect of the treatment group is better than that of the control group. 2. Chinese medicine can promote the absorption of retinal hemorrhage and exudation and compensate for the adverse reaction of retinal burn caused by laser therapy in the perioperative period of laser, so as to enhance the curative effect of laser. This synergism can significantly improve the visual acuity, shorten the course of disease, reduce the damage of visual cells and improve visual function.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.1

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